Dr. Robert A. Guida, MD

Dr. Guida states that breaking the nasal bones, or osteotomies, is an essential and safe part of rhinoplasty, necessary 95% of the time. This is crucial for centering the nose, especially with a nasal fracture, and for preventing an 'open roof deformity' (a flat, wide nasal bridge) after bump removal, which would require revision surgery. He emphasizes that osteotomies are likely needed for the best cosmetic result.

For revision rhinoplasty, Dr. Guida's practice utilizes irradiated cadaver rib allograft (cadaver rib cartilage graft). This material is chosen for its straightness and strength, which helps provide adequate tip support and achieve both cosmetic and functional results.

Dr. Guida provides nose taping instructions around eight days after extensive rhinoplasty, septoplasty, and nasal reconstruction surgery. Taping for a few hours daily over the first month helps reduce and contain natural postoperative swelling, supports the nose, and aids healing. The first piece of tape should be placed above the tip, not on it, and then other pieces are applied, overlapping and pinched. He recommends using hypoallergenic medical-grade paper tape, available in drugstores. The best time of day for taping is whatever is most convenient for the patient. Patients should expect their nose to feel stiff and swollen about a week or eight days post-surgery.

A deviated septum is a partition separating the nostrils that is sharply angulated, which can cause nasal obstruction and chronic sinusitis. If a deviated septum is suspected, Dr. Guida recommends seeing an ENT doctor and getting a CAT scan of the nose and paranasal sinuses, as this computerized X-ray provides detailed anatomy to diagnose the exact issue. If necessary, there is a very successful surgical procedure to fix the septum, leading to a straight septum, open airway, better breathing, and improved sinus drainage.

Chronic sinusitis is a recurrent infection or inflammation of the air pockets within the skull, characterized by episodes happening over weeks or months. Mucus can become trapped due to obstructions like polyps or a deviated septum, leading to infection. If left untreated, chronic sinusitis can be life-threatening, potentially leading to severe complications such as large polyps pressing on the eyeball, infection spreading to the eye (with potential for blindness), or even to the brain, causing meningitis which can be fatal. Dr. Guida emphasizes that chronic sinusitis should not be ignored. Treatment typically begins with antibiotic therapy. If antibiotics are ineffective, endoscopic sinus surgery is indicated to clean up the infection and resolve related issues, such as those affecting the eye.

Cocaine acts as a vasoconstrictor, constricting blood vessels and leading to a lack of nourishment to the nasal skin. Prolonged and excessive intranasal cocaine use can cause the bone and cartilage in the nose to melt, resulting in severe septal perforations and tissue necrosis. This damage often requires extensive reconstructive surgery, including rib grafting to rebuild the nasal dorsum and surgical repair of septal perforations. Dr. Guida emphasizes that excessive intranasal cocaine use can cause serious, even life-threatening problems.

Tipplasty is a surgical procedure performed solely on the tip of the nose, without affecting the upper two-thirds. Dr. Guida performs tipplasty for patients with concerns such as a very bulbous or wide tip, an over-projected tip, wide nostrils, or a nasal tip that is getting wider with age and lacks definition. The procedure involves refining or defining tip cartilages to create a more narrow, refined, and triangular look. He emphasizes that a tipplasty must be carefully planned and cosmetically balanced with the upper two-thirds of the nose to achieve a natural look that fits the patient's face better. During consultation, digital images are taken and altered on a computer to show patients the possible outcomes.

Dry winter air, especially in places like New York City and heated apartments, can lead to nosebleeds and discomfort. Dr. Guida recommends several measures: using a simple saline nasal spray two or three times a day, using a humidifier in your apartment to keep the air moist, and taking steam showers or sitting in a steam room two or three times a week. He advises against using a neti pot or aggressive water pick irrigation. Most importantly, he stresses hydration, recommending drinking six to eight glasses of water daily for overall and nasal health.